<!DOCTYPE html>
<%@page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8" %>

<%@taglib uri="http://www.springframework.org/tags" prefix="spring"%>
<%@taglib prefix="form" uri="http://www.springframework.org/tags/form" %>
<%@taglib prefix='c' uri='http://java.sun.com/jstl/core_rt' %>

<spring:eval var="dewResources" expression="@appProperties.getProperty('dew.static.resources.url')"/>
<spring:eval var="dewUrl" expression="@appProperties.getProperty('dew.url')"/>

<html>
    <head>
        <meta charset="utf-8"/>
        <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1"/>
        <title>DEW</title>

        <link rel="stylesheet" type="text/css" href="${dewResources}/css/bootstrap.min.css"/>
        <link rel="stylesheet" type="text/css" href="${dewResources}/css/style.css"/>
        <link rel="stylesheet" type="text/css" href="${dewResources}/css/css-all.css"/>
    </head>
    <body>
        <br/><br/><br/>
        <div>
        <h2 >Registro</h2>
    </div>
   
    <form name="fcontacto" id="fcontacto" action="" role="form" style="width: 500px">
    <div class="row">
        <div class="col-md-11">
            <label>
                Nombres (*) :</label>
            <input type="text" name="name" id="name" class="form-control" required>
        </div>
        <div class="col-md-11">
            <label>
                Apellidos (*) :</label>
            <input type="text" name="lastName" id="lastName" class="form-control" required>
        </div>
        <div class="col-md-3">
            <p style="font-weight: bold">
                G&eacute;nero :</p>
        </div>
        <div class="col-md-2">
            <div class="radio">
                <label>
                    <input type="radio" name="optionsRadios" id="optionsRadios1" value="option1" checked>
                    Masculino
                </label>
            </div>
        </div>
        <div class="col-md-2">
            <div class="radio">
                <label>
                    <input type="radio" name="optionsRadios" id="optionsRadios1" value="option1" checked>
                    Femenino
                </label>
            </div>
        </div>
        <div class="col-md-11">
            <label>
                Correo electr&oacute;nico (*) :</label>
            <input type="text" name="email" id="email" class="form-control" required>
        </div>
        <div class="col-md-11">
            <label>
                Contrase&ntilde;a :</label>
            <input type="password" name="password" id="password" class="form-control" placeholder="Password">
        </div>
        <div class="col-md-11">
            <label>
                Confirmar contrase&ntildea :</label>
            <input type="password" name="confirm" id="confirm" class="form-control" placeholder="Password">
        </div>
        <div class="col-md-11">
            <label>
                Celular :</label>
            <input type="text" name="mobile" id="mobile" class="form-control">
        </div>
        <div class="col-md-11">
            </form>
        

    <div class="col-lg-5 col-md-5 col-sm-5 col-xs-12">
        <label>Ciudad : <span></span></label><br/>
        <select name="state" class="form-control">
            <option value="Amazonas">Amazonas</option>
            <option value="Ancash">Ancash</option>
            <option value="Apurimac">Apurimac</option>
            <option value="Arequipa">Arequipa</option>
            <option value="Cajamarca">Cajamarca</option>
            <option value="Cusco">Cusco</option>
            <option value="Huancavelica">Huancavelica</option>
            <option value="Huanuco">Huanuco</option>
            <option value="Ica">Ica</option>
            <option value="Jun&iacute;n">Jun&iacute;n</option>
            <option value="La Libertad">La Libertad</option>
            <option value="Lambayeque">Lambayeque</option>
            <option value="Lima">Lima</option>
            <option value="Loreto">Loreto</option>
            <option value="Madre de Dios">Madre de Dios</option>
            <option value="Moquegua">Moquegua</option>
            <option value="Pasco">Pasco</option>
            <option value="Piura">Piura</option>
            <option value="Puno">Puno</option>
            <option value="San Mart&iacute;n">San Mart&iacute;n</option>
            <option value="Tacna">Tacna</option>
            <option value="Tumbes">Tumbes</option>
            <option value="Ucayali">Ucayali</option>
            
        </select>
        </div

</form>
       
        </div>
        
        <div class="col-md-11">
            <label>
                Distrito :</label>
            <input type="text" name="districto" id="distrito" class="form-control">
        </div>
        <div class="col-md-11">
            <label>
                Direcci&oacute;n :</label>
            <input type="text" name="line" id="line" class="form-control">
        </div>
        <div class="col-md-11">
            <div class="checkbox">
                <label>
                    <input type="checkbox">
                    He leido y acepto los t&eacute;rminos y condiciones de uso.
                </label>
            </div>
            <p class="list-group-item-text">
                Datos obligatorios (*)
            </p>
            <button id="btnRegistrase" class="btn btn-lg btn-primary btn-block" type="submit"
                style="width: 150px">
                Registrarse</button>
        </div>
    </div>
    </form>
   
        </div>
        <script src="//ajax.googleapis.com/ajax/libs/jquery/1.10.2/jquery.min.js"></script>
        <script src="${dewResources}/js/libraries/bootstrap.min.js"></script>
        <script type="text/javascript">
            DEW = {};
            DEW.staticURL = '${dewResources}';
            DEW.appURL = '${dewUrl}';

        </script>
        <script src="${dewResources}/js/register.js"></script>
    </body>
</html>